2017年 · 第130卷第23期

The health problems of children differ greatly from those of adults. A child’s response to illness and stress varies with increasing age. Pediatrics is a discipline that examines all aspects of the well-being of fetuses, infants, children, and adolescents, including their physical, mental, and psychologic growth and development. The development of pediatrics relies on innovation. Innovation is defined as the combination of new ideas, including new concepts, science, technology, and theories, which advance the development of various disciplines of pediatrics. Innovation has a strong influence on pediatrics, especially in promoting the quality of life of children, preventing diseases, and protecting children from health threats. Indeed, innovation is a driving force of the development of pediatric studies, providing the latest knowledge, theories, and technologies in pediatrics.

During the past 2 years, worldwide considerable advances have been made in the field of pediatric cardiology, including the elucidation of the mechanisms responsible for cardiovascular diseases and the development of diagnostic techniques and treatment strategies. Meanwhile, we should be aware that the genetics, environmental factors and their interactions involved in the mechanisms for a variety of pediatric cardiovascular diseases have yet been unclear. The diagnostic techniques and treatment need to be further standardized and developed.

Vasovagal syncope (VVS) is the most common cause of syncope in children. Neuropeptide Y (NPY) plays an important role in the regulation of blood pressure (BP), as well as myocardial contractility. This study aimed to explore the role of plasma NPY in VVS in children.

Fifty-six children who were diagnosed with VVS (VVS group) using head-up tilt test (HUT) and 31 healthy children who were selected as controls (control group) were enrolled. Plasma NPY concentrations were detected. The independent t-test was used to compare the data of the VVS group with those of the control group. The changes in plasma NPY levels in the VVS group during the HUT, as well as hemodynamic parameters, such as heart rate (HR), BP, total peripheral vascular resistance (TPVR), and cardiac output (CO), were evaluated using the paired t-test. Furthermore, the correlations between plasma NPY levels and hemodynamic parameters were analyzed using bivariate correlation analysis.

The BP, HR, and plasma NPY (0.34 ± 0.12 pg/ml vs. 0.46 ± 0.13 pg/ml) levels in the supine position were statistically low in the VVS group compared to levels in the control group (all P < 0.05). Plasma NPY levels were positively correlated with the HR (Pearson, R = 0.395, P < 0.001) and diastolic BP (Pearson, R = 0.311, P = 0.003) when patients were in the supine position. When patients in the VVS group were in the supine position, elevated TPVR (4.6 ± 3.7 mmHg·min⁻¹·L⁻¹ vs. 2.5 ± 1.0 mmHg·min⁻¹·L⁻¹, respectively, P < 0.001; 1 mmHg = 0.133 kPa) and reduced CO (1.0 ± 0.7 L/min vs. 2.4 ± 1.3 L/min, respectively, P < 0.001) were observed in the positive-response period compared with baseline values. The plasma NPY levels were positively correlated with TPVR (Spearman, R = 0.294, P = 0.028) but negatively correlated with CO in the positive-response period during HUT (Spearman, R= −0.318, P = 0.017).

Plasma NPY may contribute to the pathogenesis of VVS by increasing the TPVR and decreasing the CO during orthostatic regulation.

Percutaneous balloon pulmonary valvuloplasty (PBPV) is the preferred therapy for pulmonary valve stenosis (PVS). This study retrospectively reviewed recent PBPV outcomes in infants with PVS. The aim of this study was to evaluate factors associated with immediate therapeutic outcomes and restenosis during medium-term follow-up.

The study included 158 infants with PVS who underwent PBPV from January 2009 to July 2015. Demographic characteristics and patient records were reviewed, including detailed hospitalization parameters, hemodynamic data before and immediately after balloon dilation, cineangiograms, and echocardiograms before PBPV and at each follow-up. All procedures were performed by more than two experienced operators.

Immediately after balloon dilation, the pressure gradient across the pulmonary valve decreased from 73.09 ± 21.89 mmHg (range: 43-151 mmHg) to 24.49 ± 17.00 mmHg (range: 3-92 mmHg; P < 0.001) and the right ventricular systolic pressure decreased from 95.34 ± 23.44 mmHg (range: 60-174 mmHg) to 52.07 ± 18.89 mmHg (range: 22-134 mmHg; P < 0.001). Residual transvalvular pressure gradients of 67.31 ± 15.19 mmHg (range: 50-92 mmHg) were found in 8.2% of patients, indicating poor therapeutic effects; 6.4% of patients had variable-staged restenosis at follow-up and 3.8% underwent reintervention by balloon dilation or surgical repairs. Further analysis demonstrated that the balloon/annulus ratio showed statistically significant differences (P < 0.05) among groups with different therapeutic effects and between the restenosis and no-stenosis groups. Binary logistic regression analysis further revealed that higher balloon/annulus ratio (odds ratio: 0.005, 95% confidence interval: 0-0.39) was an independent protective factor for restenosis. The rate of severe complications was 1.9%.

PBPV is a definitive therapy for infants with PVS based on its effectiveness, feasibility, and safety. Restenosis upon medium-term follow-up is relatively rare.

Pulmonary stenosis is common in children with complex congenital heart diseases. Proper management of this problem, especially postoperatively, is still controversial. This study was designed to assess the rate and determinants of success or failure of balloon angioplasty for such lesions.

Clinical and hemodynamic data from 40 pediatric patients (24 boys and 16 girls) with complex congenital heart diseases who underwent balloon angioplasty were reviewed retrospectively from January 2012 to December 2016. Patients were divided into four groups according to the site of stenosis, which included pulmonary valve stenosis (PVS), valved conduit stenosis, pulmonary artery stenosis (PAS), and supravalvular pulmonary stenosis (SVPS). Success rates were calculated according to defined criteria for initial success and favorable clinical impacts, and comparison between the successful subgroup and the unsuccessful subgroups was analyzed.

Grouped by the site of stenosis, initial success rates varied from 40.0% to 52.4% with the greatest success being seen in the PVS group, followed by the PAS group and SVPS group. In the PVS group and the PAS group, there was no statistical difference among age at dilation, postoperative interval, balloon/stenosis ratio, or pressure gradient predilation between the successful and the unsuccessful subgroups. Favorable clinical impacts included success rates of balloon angioplasty in the SVPS group, which was best (100%), followed by the PVS group (90.9%) and the PAS group (85.7%). There were a total of two transient complications (5.0%).

Balloon angioplasty was proven to be a safe and useful modality in children with complex congenital heart diseases and postoperative pulmonary stenosis, which should be the initial therapeutic modality in selected patients.

Coarctation of the aorta (CoA) with aortic arch hypoplasia (AAH) is a relatively common congenital heart disease in clinical practice. Nonetheless, the corrective surgical technique for infants and children is a clinical problem that remains controversial. In this study, we sought to evaluate the surgical effects of aortic arch (AA) reconstruction with coarctation resection and aortoplasty with autologous pulmonary artery patch for infants and young children with CoA and AAH.

Between January 2009 and December 2015, a total of 22 infants and young children with CoA and AAH who underwent coarctation resection and aortoplasty with autologous pulmonary artery patch were enrolled in this study. The median age of patients was 4.5 (Q1, Q3: 2.0, 14.0) months and the median body weight was 5.75 (Q1, Q3: 4.10, 9.38) kg. All patients were diagnosed with CoA and AAH, and concomitant cardiac anomalies were corrected in one stage. Perioperative and postoperative data were collected and analyzed using the paired sample t-test.

No perioperative deaths occurred. No residual obstruction was detected by echocardiography. The postoperative pressure difference across the repaired segment of CoA was 14.05 ± 4.26 mmHg (1 mmHg = 0.133 kPa), which was smaller than the preoperative pressure difference (48.30 ± 15.73 mmHg; t= −10.119, P < 0.001). The median follow-up time was 29.0 (Q1, Q3: 15.5, 57.3) months. There was no death during the follow-up period, and all patients experienced obvious clinical improvement. Only one child underwent subsequent aortic balloon angioplasty due to restenosis. Computed tomography angiography showed that the AA morphology was smooth, with no aortic aneurysm or angulation deformity.

AA reconstruction with coarctation resection and aortoplasty with autologous pulmonary artery patch could effectively correct CoA with AAH, and the rate of reintervention for restenosis is low.

The patients with early-onset epileptic encephalopathy (EOEE) suffer from neurodevelopmental delay. The aim of this study was to analyze the clinical manifestations and amplitude-integrated encephalogram (aEEG) characteristics of infants with EOEE with onset within the neonatal period, to make early diagnosis to improve the prognosis.

One-hundred and twenty-eight patients with neonatal seizure were enrolled and followed up till 1 year old. Sixty-six neonates evolved into EOEE were as the EOEE group, the other 62 were as the non-EOEE (nEOEE) group. Then we compared the clinical and aEEG characteristics between the two groups to analyze the manifestations in neonates with EOEE.

Compared to the nEOEE group, the incidence of daily seizure attacks, more than two types of convulsions, more than two antiepileptic drugs (AEDs) application, severely abnormal aEEG background, absence of cyclicity, and more than two seizures detection were significantly higher in the EOEE group (P < 0.05) (97% vs. 54.8%; 30.3% vs. 14.5%; 97.0% vs. 25.4%; 39.4% vs. 3.2%; 57.6% vs. 9.7%; and 56% vs. 3.2%, respectively). Severely abnormal background pattern (odds ratio [OR] = 0.081, 95% confidence interval [CI]: 0.009- 0.729, P = 0.025) and more than two seizures detection by aEEG (OR = 0.158, 95% CI: 0.043- 0.576, P = 0.005) were the independent risk factors for the evolvement into EOEE. The upper and lower margins of active sleep (AS) and quiet sleep (QS) were significantly higher in EOEE group than those of the control group (P < 0.05) (34.3 ± 13.6 vs. 21.3 ± 6.4; 9.9 ± 3.7 vs. 6.7 ± 2.2; 41.2 ± 15.1 vs. 30.4 ± 11.4; and 11.9 ± 4.4 vs. 9.4 ± 4.0; unit: μV, respectively). AS upper margin was demonstrated a higher diagnostic specificity and sensitivity for EOEE than another three parameters according to the receiver operating characteristic curves; the area under the curve was 0.827.

The clinical characteristics of the neonatal seizure which will evolve into EOEE were more than two AEDs application, high seizure frequency (daily attack), and more than two types of the seizure. Significant high voltage, severely abnormal background, absence of cyclicity, and more than two seizures detected on aEEG were the meaningful indicators to the prediction of EOEE.

Anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) is a rather rare congenital anomaly that has a profound effect on heart function. This study aimed to retrospectively illustrate the perioperative clinical features, therapy experience, and midterm outcomes after surgical correction, and to determine the value of left ventricular ejection fraction (LVEF) and myocardial viability in differentiating critically ill patients among infants and children with ALCAPA.

From April 1999 to March 2013, infants and children patients diagnosed with ALCAPA in Beijing Fuwai Hospital were analyzed. Clinical data of patients were summarized and retrospectively analyzed. All patients were divided into two groups according to LVEF level (Group 1: LVEF >50%, or Group 2: LVEF ≤50%) to compare perioperative and follow-up variables. Effect of myocardial viability evaluated according to myocardial perfusion/¹⁸F-fluorodeoxyglucose (FDG) imaging on the clinical variables was also analyzed.

A total of 50 patients with ALCAPA (male/female: 29/21; median age: 3.1 years [range: 4 months to 18 years]) were included. Younger age, lower weight, intercoronary collaterals (ICC) dysplasia, ratio of the proximal right coronary artery diameter to the aortic root diameter <0.2, and larger cardiothoracic ratio (CTR) were more frequently found in Group 2 than those in Group 1. Forty-seven patients underwent cardiac surgery. The times of cross-clamp and cardiopulmonary bypass were not different between the two groups; however, the duration of mechanical ventilation and postoperative Intensive Care Unit stay were longer in Group 2 than those in Group 1. Follow-ups were possible in 38 patients (80.9%); median time: 84.5 months (range: 49 months to 216 months). There was one late sudden death with simple ligation of the LCA at 8 months after surgery. No severe complications and reoperation occurred. The relationship of the grades of myocardial viability and clinical features was analyzed in 15 patients with myocardial perfusion/¹⁸F-FDG imaging, and the results showed that myocardial viability correlated well with LVEF, CTR, abnormal Q waves, and left ventricular end-diastolic dimension. It was not correlated with age, mitral regurgitation, and ICC. Heart implantation was decided in one patient with little viable myocardium; however, this patient died 2 months after the diagnosis while waiting for transplantation. Two patients with no viable myocardium in the area of aneurysm had aneurysmectomy concomitantly.

In infants and children with ALCAPA, heart function and myocardial viability are closely related to clinical features. LVEF and the grades of myocardial viability can differentiate high-risk patients before surgery and in the early stage of recovery after surgery. The area and extent of myocardial infarction are also crucial in making preoperative clinical decisions. However, even in patients with depressed ventricular function and severe myocardial infarction, the midterm follow-up showed satisfactory recovery of cardiac function after the successful restoration of a dual-coronary arterial system.

Restrictive cardiomyopathy (RCM) is the least common cardiomyopathy in which the walls are rigid and the heart is restricted from stretching and filling properly. Cardiac troponin I (cTnI) mutation-caused myofibril Ca²⁺ hypersensitivity has been shown to be associated with impaired diastolic function. This study aimed to investigate the linkage between the genotype and clinical therapy of RCM.

Five sporadic pediatric RCM patients confirmed by echocardiography were enrolled in this study. Whole-exome sequencing (WES) was performed for the cohort to find out candidate causative gene variants. Sanger sequencing confirmed the WES-identified variants.

TNNI3 variants were found in all of the five patients. R192H mutation was shared in four patients while R204H mutation was found only in one patient. Structure investigation showed that the C terminus of TNNI3 was flexible and mutation on the C terminus was possible to cause the RCM. Catechins were prescribed for the five patients once genotype was confirmed. Ventricular diastolic function was improved in three patients during the follow-up.

Our data demonstrated that TNNI3 mutation-induced RCM1 is the most common type of pediatric RCM in this study. In addition, WES is a reliable approach to identify likely pathogenic genes of RCM and might be useful for the guidance of clinical treatment scheme.

Safflower extract and aceglutamide (SA) has been used clinically for the treatment of cerebrovascular diseases such as cerebral embolism, hemorrhage, and mental deterioration. This study aimed to investigate the effect and mechanism of SA injection in the recovery of peripheral innervations of diabetic mice.

The C57BL/6 male mice were divided into four groups: normal control group (n = 44), diabetic group (n = 44), diabetic + SA group (diabetic mice treated with SA injection, n = 44), and diabetic + SA + vascular endothelial growth factor receptor (VEGFR)1-BL group (diabetic mice treated with SA injection and VEGFR 1 blocking antibody n = 24). The streptozotocin-induced diabetic mice model and injured peripheral nerve mice model were built. The mice with injured peripheral nerves were intraperitonealy administered with SA injection for successive 21 days. The corneal sensitivity, number of corneal nerve fibers, and contents of vascular endothelial growth factor (VEGF)-B and various neurotrophic factors such as nerve growth factor (NGF) and glial cell line-derived neurotrophic factor (GDNF) in corneal tissue of four groups were observed.

The diabetic group showed decreased number of corneal nerve fibers, compared with the control group (P = 0.002). And compared with the diabetic group, the diabetic + SA group showed a significant increase in the number of nerve fibers (P = 0.024) and the contents of VEGF-B, NGF, and GDNF in the cornea (all P < 0.05). However, when the diabetic mice were treated with the blocking antibodies specialized for VEGF-B receptor, the neutralization of VEGFR-1 completely abolished the increased expression of NGF and GDNF stimulated by SA injection.

SA injection could reduce the nerve injury caused by diabetic peripheral neuropathy, and its protective effect might be associated with the promotion of the expressions of VEGF-B, NGF, and GDNF.

China began to implement the national medical and health system and public hospital reforms in 2009 and 2012, respectively. Anhui Province is one of the four pilot provinces, and the medical reform measures received wide attention nationwide. The effectiveness of the above reform needs to get attention. This study aimed to master the efficiency and productivity of county-level public hospitals based on the data envelopment analysis (DEA) model and Malmquist index in Anhui, China, and then provide improvement measures for the future hospital development.

We chose 12 country-level hospitals based on geographical distribution and the economic development level in Anhui Province. Relevant data that were collected in the field and then sorted were provided by the administrative departments of the hospitals. DEA models were used to calculate the dynamic efficiency and Malmquist index factors for the 12 institutions.

During 2010-2015, the overall average relative service efficiency of 12 county-level public hospitals was 0.926, and the number of hospitals achieved an effective DEA for each year from 2010 to 2015 was 4, 6, 7, 7, 6, and 8, respectively, as measured using DEA. During this same period, the average overall production efficiency was 0.983, and the total productivity factor had declined. The overall production efficiency of five hospitals was >1, and the rest are <1 between 2010 and 2015.

In 2010- 2015, the relative service efficiency of 12 county-level public hospitals in Anhui Province showed a decreasing trend, and the service efficiency of each hospital changed. In the past 6 years, although some hospitals have been effective, the efficiency of the county-level public hospitals in Anhui Province has not improved significantly, and the total factor productivity has not been effectively improved. County-level public hospitals need to combine their own reality to find their own deficiencies.

Practice guidelines have recommended cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) as the treatment of choice for major depression disorder (MDD). However, whether one therapy is better than the other remains inconclusive. The aim of this study was to compare the treatment efficacy of the two treatment approaches for MDD.

Using the terms "cognitive behavior therapy or cognitive therapy or CBT or CT or cognitive behavioral therapy" and "interpersonal psychotherapy or IPT," we systematically searched PubMed, Psyclnfo and Chinese National Knowledge Infrastructure databases up to February 2017. The language was restricted to be English and Chinese. Therapeutic outcomes, characteristics, and research quality were then extracted and analyzed independently. In accessing the included studies, we followed the criteria suggested by the Cochrane Handbook for Systematic Reviews of Interventions.

Data for 946 patients from 10 randomized controlled trials were included in the study. Methodological quality was not optimal in most trials. Meta-analysis showed a mean difference (MD) of −1.31, 95% confidence interval (CI) (−2.49, −0.12) (P < 0.05) in favor of CBT according to the Beck Depression Inventory (BDI), and however, we did not found any statistically significant difference between CBT and IPT on the Hamilton Rating Scale for depression (HRSD) (MD −0.90, 95% CI [−2.18, 0.38]). Subgroup analyses for the studies in which patients were treated only by psychotherapy (MD −1.26, 95% CI [−2.78, 0.35]) and for those which offered more sessions of therapies (MD −0.82, 95% CI [−2.23, 0.59]) showed there was no significant difference between CBT and IPT according to BDI.

Differences in treatment efficacy seem to vary according to different outcome measures. CBT shows an advantage over IPT for MDD according to BDI, and there is no significant difference between the two according to HRSD. These results should be interpreted with caution.

Chlamydia trachomatis(Ct) genital infection is the most common sexually transmitted disease (STD) in China and the US. The morbidity of Ct genital infection in China has increased from 32.48/100,000 in 2008 to 37.18/100,000 in 2015.[1] The major areas of Ct infections are concentrated in the Zhujiang Delta, Changjiang Delta, Minjiang Area, and West China. In these areas, the highest incidence of Ct infection reaches 615.99/100,000 citizens. In the US, there are 1,441,789 reported Ct, which include 627.2 females and 278.4 males per 100,000 population. It is now the most prevalent STD, with its rate increasing to 22% in males and 6% in females.[2] Ct genital infection can cause epididymitis, prostatitis, cervicitis, annexitis, infertility, and atopic pregnancy, which have been identified as the major public health problems.

Vitamin D is a group of fat-soluble molecules that are structurally similar to steroids. Emerging data have led to the hypothesis that Vitamin D plays a role in the regulation of many physiological processes beyond calcium and phosphorus homeostasis. With this review, we aimed to summarize the changes in Vitamin D levels in children with cardiovascular diseases based on the literature. In addition, we also reviewed the potential mechanisms underlying cardiovascular diseases associated with Vitamin D deficiency or insufficiency.

The articles in English were searched from PubMed (1968- 2016) and EMBASE (1991- 2016), with the keywords of "Vitamin D AND cardiovascular diseases" and "Vitamin D AND children." Study Selection: Original articles and critical reviews about Vitamin D and cardiovascular risk in children were selected for review. Researches focused on adults were excluded.

Studies have shown that several pediatric cardiovascular diseases may be associated with Vitamin D deficiency or insufficiency, including hypertension, orthostatic intolerance, and Kawasaki disease.

Vitamin D may play a role in the regulation of the cardiovascular system. Further investigation would hopefully disclose the usefulness of Vitamin D as a biomarker for cardiovascular diseases in children.

Congenital heart block (CHB) is a rare but life-threatening disorder. More than half of CHB cases are associated with maternal autoimmune, which are termed as autoimmune-associated CHB. This review summarized the recent research findings in understanding autoimmune-associated CHB, discussed the current diagnostic approaches and management strategies, and summarized the problems and future directions for this disorder.

We retrieved the articles published in English from the PubMed database up to January 2017, using the keywords including "Autoimmune-associated" , "Autoimmune-mediated" , and "Congenital heart block" . Study Selection: Articles about autoimmune-associated CHB were obtained and reviewed.

Observational studies consistently reported that transplacental maternal antibodies might recognize fetal or neonatal antigens in various tissues and result in immunological damages, but the molecular mechanisms underlying CHB pathogenesis still need illuminated. Multiple factors were involved in the process of atrioventricular block development and progression. While several susceptibility genes had been successfully defined, how these genes and their protein interact and impact each other remains to be explored. With currently available diagnostic tools, fetal ultrasound cardiography, and fetal magnetocardiography, most of CHB could be successfully diagnosed and comprehensively evaluated prenatally. The efficacy of current approaches for preventing the progression and recurrence of CHB and other autoimmune-mediated damages was still controversial.

This review highlighted the relationships between autoimmune injuries and CHB and strengthened the importance of perinatal management and therapy for autoimmune-associated CHB.

The management of medical quality is the core element of hospital management, and it is reflected in every part and aspect of medical behavior. Strengthening the management on medical quality is crucial in ensuring medical safety, promoting the ability of clinical diagnoses and treatments as well as the increasing the efficiency of medical service.[1] On this basis, the establishment and operation of a comprehensive evaluation system on medical quality is not only the foundation in ensuring the orderly operation of the medical behavior and medical safety but also an effective means in continuously improving the quality of medical management.[2] This paper aims to discuss the establishment of an operable and objective evaluation system as well as the corresponding assessment indicators on internal medical quality within the hospital based on cross-examination of departments through extensive research into various national and regional medical quality evaluation systems, and practice was carried out to achieve the purpose of the continuous improvement in medical quality as well as ensuring medical safety.

Syncope is caused by transient cerebral ischemia, for various reasons, leading to the loss of consciousness and muscle tension maintenance, resulting fainting of the patients. It is a common emergency for children and adolescents. A statistical analysis shows that about 15-25% of children and adolescents had suffered syncope at least once. Suffering syncope has greatly impacts on physical and mental health of children in various degrees.

Goldenhar syndrome, also known as oculo-auriculo-vertebral dysplasia, is characterized by a wide range of congenital anomalies, such as micrognathia, oral cavity malformations, and vertebral anomalies and always causes difficult airway. Awake intubation often cannot be used on children because of inadequate cooperation. In addition, children have higher rates of oxygen consumption, significantly shortening the period of apnea that can be safely tolerated. This study reported a successful orotracheal intubation using the McGrath^®video laryngoscope combined with a fiberoptic bronchoscope (FOB) in a pediatric patient with Goldenhar syndrome.

Hajdu-Cheney syndrome (HCS) is a rare disorder which is characterized by developmental delay, craniofacial anomalies, congenital heart defects, hearing deficit, polycystic kidneys, and bone abnormalities, including progressive osteoporosis, acroosteolysis, wormian bones, and abnormal bone fractures.[1] Truncating mutations in Notch homolog protein 2 gene (NOTCH2) are the principal cause of HCS. Here, we described the clinical manifestations, laboratory examinations, and molecular genetic analysis and evaluation of immunological function in a Chinese family with a novel mutation inNOTCH2.Patient 1 (son) was a 4-year-old Chinese boy. He was diagnosed with patent ductus arteriosus (PDA) and pneumonia 4 days after he was born. At 1 year old, he presented with the symptoms of acroosteolysis which was not taken seriously. At 1 year and 9 months old, he was diagnosed with pulmonary hypertension and ventricular septal defect. He received transcatheter occlusion of PDA immediately. At 3.5 years old, his pulmonary artery pressure was 90 mmHg after mild exercise and decreased to 68 mmHg after taking bosentan for 2 months. He had repeated infections, about three times a year since he was born. At 4 years old, he presented with a large anterior fontanelle, low-set ears, bushy eyebrows, synophrys, shallow orbit, mild proptosis, hypertelorism, flat nasal bridge, micrognathia, downslanted palpebral fissures, short neck, stubby fingers, and joint hypermobility [Figure 1aandFigure 1c]; and his immunoglobulin E (IgE) increased (no exact data), but without allergic symptom.

In 2015, the incidence rate of thyroid cancer was 4.2/100,000 in China, which accounted for 2.1% of all new cancer cases.[1] Aneurysms of the carotid artery or its branches account for only 0.4% of all peripheral artery aneurysms.[2] The coexistence of these two lesions has seldom been observed. Here, we reported a case of a superior thyroid artery (STA) aneurysm with concomitant thyroid cancer and discussed surgical treatment strategies.

Point-of-care transthoracic echocardiography (TTE) is an evolving field in anesthesia field and verified to have the potential to provide rapid diagnostic information during the hemodynamic collapse in operating room.[1] In this retrospective observatory study, we retrieved all the data of 1-year consecutive use of intraoperative echocardiography in patients with circulatory collapse or undergoing selective high-risk noncardiac surgery.

Staphylococcus aureusis associated with a variety of invasive infection; typically, these infections occur as sepsis, osteomyelitis, endocarditis, and arthritis. China has a relatively high incidence of invasiveS. aureusdisease in children.[1] The present study aimed to provide the demographics, clones, and the antimicrobial susceptibility ofS. aureusthat cause invasive infection in Chinese children. InvasiveS. aureusinfection refers toS. aureusisolated from a normally sterile body site, including blood, pleural effusion, cerebrospinal fluid, joint effusion, and bone marrow, or a skin and soft tissue infection (SSTI) requiring hospital admission for surgical drainage/debridement under general anesthetic and/or intravenous antimicrobial therapy.[2] PCR amplification was used for multilocus sequence typing, agr typing, andspatyping. A total of 274 children (≤14 years old) between February 2016 and January 2017 in Beijing Children’s Hospital had positiveS. aureusclinical microbiology reports. Among these 274 children, 30 patients were classified as having invasiveS. aureusinfection; the incidence was 10.9% (30/274). Among these 30 patients, 8 patients were <1 month old, 11 patients between 2 months and 6 years, and 11 patients between 10 years and 14 years; 11 patients were infected by methicillin-resistantS. aureus(MRSA) and 19 by methicillin-susceptibleS. aureus(MSSA); 8 patients suffered from single-site infection, 12 from two-site infection, and 10 from multi- site infection. Twenty-two (22/30) were hospitalized, and five (5/22) of them gave up for treatment, and one (1/5) died immediately.

Kawasaki disease shock syndrome (KDSS) refers to Kawasaki disease (KD) patients who present more than 20% decrease in systolic blood pressure compared to healthy individuals of the same age, or to those patients who show peripheral blood circulation perfusion disorder. KDSS may have varied clinical courses and could be easily ignored and misdiagnosed. Yet, this syndrome could be deleterious, especially when combined with coronary artery injury or multiple organ dysfunctions. Therefore, early diagnosis of KDSS through specific clinical manifestations is critical. This manuscript summarizes the clinical features and treatment methods of 11 children with KDSS who were able to fully recover in our hospital. The results shed lights on understanding the early identification of KDSS and could assist in reducing the complications of KD and improving the quality of life in KDSS patients.

To the Editor: Liraglutide Effect and Action in Diabetes: Evaluation of cardiovascular outcome results (LEADER) trial illustrated that among patients with type 2 diabetes mellitus, those in the liraglutide group had lower rates of cardiovascular events and death from any cause than did those in the placebo group.^[1]Herein, we reported a case of an increase of heart rate (HR) and electrocardiographic changes after subcutaneous liraglutide.

To the Editor: Clonorchiasis is a biliary tract disease caused byClonorchis sinensis, which is widely distributed in East Asia, including China. Diffuse parenchymal lung diseases (DPLDs) comprise a large and heterogeneous group of disorders characterized by diffuse infiltrates, restrictive functional defect, and disordered gas exchange.C. sinensisinfection is seldom associated with pulmonary manifestation. Here, we report a case of clonorchiasis complicated with DPLD in a child.

To the Editor: Nevus sebaceous (NS) is an epidermal nevus that is comprised predominantly of sebaceous glands in approximately 0.3% of newborns.[1] Clinically, it presents as a single or, less commonly, multiple yellowish-colored plaques with overlying alopecia, usually confined on the scalp; however, it can also appear on the face, preauricular area, and neck region.^[2,3]Here, we reported a case of NS in a discrete linear pattern located on the left chest region, in contrast with typical cases, to assist physicians in the early diagnosis of this condition and to prevent unnecessary examinations and inadequate therapeutic interventions.